NPSI April 2026 Scientific Meeting: "Freud's 'Open Wounds' of Melancholia: Psychic Inflammation as Self-Healing" presented by Nancy C. Winters, MD, FIPA

Sigmund Freud’s “Mourning and Melancholia” (1917) remains the foundational psychoanalytic account of depression, offering enduring insights into its genesis and its notorious resistance to treatment. Nancy Winters revisits Freud’s intriguing observation that “the complex of melancholia behaves like an open wound, drawing to itself cathectic energies . . . from all directions, and emptying the ego until it is totally impoverished.” For Freud, this “open wound”—and what distinguishes it from mourning—is seen in the melancholic’s severe self-denigration. As Freud observes astutely, the true target of the melancholic’s self-reproaches is the lost love object, taken into the ego through identification. Winters reconsiders the melancholic’s self-accusations as a mode of truth-seeking that may be understood as an attempt to heal this open wound, in line with Freud’s (1911) view of the symptom itself as an effort at recovery. She conceptualizes this process as a form of psychic inflammation, analogous to biological inflammation in its dual capacities for pain and healing, as well as its pathological extreme in the autoimmune self-attack (Winters, 2022). Clinical vignettes illustrate how this ‘inflammation’ can manifest as a search for the most damning truth about oneself—understood dynamically as an effort to loosen the identification with the introjected object and ultimately to restore life-enhancing libido to the depleted ego.